Panic Attacks: What's Happening in the Body and Mind

Understanding the physical and psychological mechanisms behind panic attacks and why they feel so terrifying.

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Reviewed by the HeyPsych Medical Review Board

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Medical Review Board

Published: January 15, 2024

Last Updated: January 9, 2026

Last Reviewed: January 9, 2026

Article

6 min read

Overview

A panic attack feels like you're dying. Your heart pounds, you can't breathe, your chest tightens. It's one of the most terrifying experiences a person can have. But here's the crucial truth: panic attacks, while overwhelming, are not dangerous. Understanding what's actually happening in your body and mind during a panic attack can make them less frightening.

What Is a Panic Attack?

A panic attack is a sudden surge of overwhelming fear and physical symptoms that peaks within minutes. Defining characteristics: • Comes on suddenly (reaches peak intensity in 10 minutes or less) • Involves intense fear or discomfort • Includes at least 4 physical or psychological symptoms • Usually lasts 20-30 minutes total • Leaves you feeling drained afterward Key insight: A panic attack is your body's alarm system going off when there's no actual danger. It's a false alarm, but your body responds as if the threat is real and life-threatening.

The Fight-or-Flight Response

Panic attacks are an extreme activation of your body's ancient survival mechanism. What happens: • Your brain (specifically, the amygdala) detects a threat • The hypothalamus signals the adrenal glands • Adrenaline and cortisol flood your system • Your body prepares to fight or run from danger The problem: In panic attacks, this system activates without real danger. Your brain misinterprets safe situations (a crowded store, being alone, feeling your heart beat) as life-threatening. Evolutionary context: This response kept our ancestors alive when facing predators. Today, it's triggered by perceived psychological threats, but your body doesn't know the difference between a lion and a presentation.

Physical Symptoms: What's Happening and Why

Racing heart: • Why: Heart pumps faster to send blood to muscles for escape • What it feels like: Pounding, racing, or irregular heartbeat • Reality: Uncomfortable but not dangerous; panic attacks don't cause heart attacks Difficulty breathing: • Why: Breathing speeds up to get more oxygen • What it feels like: Can't catch your breath, chest tightness, suffocating sensation • Reality: You're getting too much oxygen (hyperventilation), not too little Dizziness and lightheadedness: • Why: Hyperventilation changes blood chemistry (lowers CO2) • What it feels like: Wobbly, unsteady, like you might faint • Reality: Panic raises blood pressure, which actually prevents fainting Trembling or shaking: • Why: Muscles tense in preparation for action • What it feels like: Visible shaking, internal tremors • Reality: Discharge of nervous system activation Sweating: • Why: Body cools itself for physical exertion • What it feels like: Sudden sweating, hot flashes • Reality: Normal stress response Chest pain or discomfort: • Why: Chest muscles tense, breathing pattern changes • What it feels like: Pressure, tightness, sharp pain • Reality: Muscular tension, not heart problems Nausea or stomach distress: • Why: Digestion shuts down (not needed for survival) • What it feels like: Upset stomach, nausea, butterflies • Reality: Blood diverted from digestive system to muscles Tingling or numbness: • Why: Changes in blood flow and breathing affect nerve sensations • What it feels like: Pins and needles in hands, feet, face • Reality: Temporary and harmless Chills or hot flashes: • Why: Body temperature regulation affected by stress response • What it feels like: Sudden temperature changes • Reality: Autonomic nervous system activation

Psychological Symptoms: The Mind During Panic

Fear of dying: • The physical sensations are so intense, your brain interprets them as life-threatening • You become convinced something terrible is happening • This fear amplifies the physical symptoms, creating a feedback loop Fear of losing control or "going crazy": • The intensity feels unmanageable • You worry you'll do something embarrassing or harmful • Reality: People don't lose control during panic attacks; you remain aware and in control of your actions Derealization (feeling of unreality): • The world feels dreamlike, foggy, or distant • Things seem unreal or distorted • Why: Your brain's threat detection system changes perception to focus on danger Depersonalization (detachment from self): • You feel disconnected from your body or thoughts • Observing yourself from outside • Why: A protective mechanism to distance yourself from overwhelming experience Sense of impending doom: • Overwhelming feeling that something catastrophic will happen • Can't identify what, but the dread is intense • Why: Your amygdala is screaming "danger!" even without specific threat

The Panic Cycle: How It Feeds Itself

The vicious cycle: 1. Trigger: Internal sensation (rapid heartbeat) or external situation (crowded place) ↓ 2. Perception: "Something is wrong" ↓ 3. Anxiety: Worry about the sensation ↓ 4. Physical symptoms: Increased heart rate, breathing, tension ↓ 5. Catastrophic thought: "I'm having a heart attack" or "I'm going crazy" ↓ 6. More fear: Panic intensifies ↓ 7. More physical symptoms: The loop continues Breaking the cycle: Understanding this cycle is the first step. When you recognize what's happening, you can intervene at the thought level ("This is panic, not danger") or physical level (slow breathing to calm the body).

Why You Can't Die from a Panic Attack

Common fears vs. reality: "I'm having a heart attack": • Panic raises heart rate but doesn't damage the heart • Young, healthy hearts can't be harmed by panic • Heart attack pain is different (crushing, radiating to arm/jaw, during exertion) • EKG during panic attack shows normal rhythm, just fast "I'm going to pass out": • Panic increases blood pressure • Fainting happens when blood pressure drops • These are opposite mechanisms • You can't faint from panic (though you might feel like you will) "I'm going to suffocate": • Hyperventilation means too much oxygen, not too little • The tight chest feeling is muscle tension, not lack of air • Your body has reflexes that prevent suffocation "I'm going to lose control": • No one has ever "gone crazy" from a panic attack • You remain aware and capable of rational action • The feeling of losing control is just that—a feeling The biological truth: Panic attacks are time-limited by biology. Adrenaline gets metabolized. Your body can't sustain that level of arousal indefinitely. Even without intervention, panic peaks and then naturally subsides.

Brain Regions Involved

The panic network: Amygdala (fear center): • Detects threats (real or perceived) • Triggers the alarm before conscious thought • Overactive in panic disorder • Acts faster than rational thinking Hippocampus (memory): • Associates contexts with danger • Why panic can occur in specific places • Stores memories of previous panic attacks • Can trigger panic in similar situations Prefrontal cortex (rational brain): • Interprets and evaluates threats • Provides context and reason • Underfunctioning during panic • Why you can't "think your way out" in the moment Hypothalamus (control center): • Activates the stress response • Signals adrenal glands to release hormones • Controls the cascade of physical symptoms Locus coeruleus: • Produces norepinephrine (alertness chemical) • Hypersensitive in panic disorder • Triggers arousal throughout the brain and body What this means: Panic isn't weakness or lack of willpower. It's a neurological process involving multiple brain systems. Understanding this helps remove shame and blame.

Why Panic Attacks Develop

Biological vulnerability: • Genetics (runs in families) • Brain chemistry differences • Oversensitive fear circuitry • Some people's alarm systems have a lower threshold Learned associations: • Experiencing panic in a specific place creates association • Your brain learns to fear panic itself (fear of fear) • Avoidance strengthens the fear • Each attack can increase sensitivity Stress and sensitization: • Chronic stress lowers panic threshold • Sleep deprivation, caffeine, illness make you more vulnerable • Life transitions and major stressors • Accumulated stress "primes" the system Misinterpretation of body sensations: • Normal bodily fluctuations (heart rate changes, breathing shifts) • Hypervigilance to physical sensations • Catastrophic interpretation triggers alarm • Creates self-fulfilling prophecy

Panic Disorder vs. Isolated Panic Attacks

Isolated panic attacks: • Can happen to anyone under extreme stress • May occur once and never again • Don't significantly impact life • About 11% of people have a panic attack in a given year Panic disorder: • Recurrent, unexpected panic attacks • Persistent worry about future attacks (at least one month) • Behavioral changes (avoidance) • Significant impact on daily life • About 2-3% of people have panic disorder Agoraphobia: • Develops in some people with panic disorder • Fear of places where escape would be difficult • Avoidance of situations (crowds, public transit, open spaces) • Can become severely limiting

The Aftermath: Why You Feel Exhausted

After a panic attack: • Deep fatigue and exhaustion • Muscle soreness • Emotional depletion • Sometimes residual anxiety • Occasionally euphoria or relief Why: • Your body just went through intense physiological activation • Stress hormones need to be metabolized • Muscles were tensed for 20-30 minutes • Mental and emotional energy was expended • It's like running a sprint—you need recovery time This exhaustion doesn't mean something is wrong. It's a normal aftermath of your body's stress response.

Conclusion

Panic attacks are a malfunction of your body's protective alarm system—terrifying, but not dangerous. Every symptom you experience during panic has a biological explanation and purpose, even though the alarm is false. Understanding what's happening in your body and mind doesn't make panic comfortable, but it can make it less frightening. When you know it's "just" panic (and that panic can't hurt you), you're less likely to fear the panic itself—and that's often the key to breaking the cycle.